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Evaluation of process and possible outcomes

PICOT Question

 

Olivia Timmons

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St. John’s River State College

App Evidence-Based Practice in Nursing

Professor Graham

June 6th, 2021

 

 

 

 

 

 

 

 

 

 

PICOT Question

Appeals for point-of-care test (POCT) instruments are often based on the assumption that speedier findings would typically result in improved hospital stays because of more focused therapy. Rapid test result turnaround time, referred to as POCT, may enhance care if a result is needed for a time-sensitive clinical intervention, such as blood sugar levels just before meals to ensure proper insulin dosage timing and injection. However, the research does not yet clearly demonstrate that POCT significantly enhances inpatient care. POCT requests in the emergency department (ED) anticipate that fast results would not only expedite diagnosis, therapy, and monitoring but will also inevitably and significantly result in a shorter total length of stay in the ED (ED-LOS). Reduced ED-LOS per patient equates to increased patient throughput, less ED congestion, enhanced patient care, and overall better utilization of ED resources. As with the hospitalized experience, it is unclear if quicker POCT findings result in improved ED patient care management, resulting in a shorter ED-LOS; furthermore, it is unclear how much evidence exists to support that assertion and for which tests and/or illness conditions.

Literature Review.

The primary advantage of POCT is that it may be conducted quickly and by clinicians who are not educated in clinical laboratory sciences. Rapid test results may give physicians—and other clinical personnel—information that can be used to decide a patient’s course of action or therapy rapidly. This has clear advantages in almost every situation, from the emergency department to the home of a client receiving home-based care. Having an improved and faster accessibility to test results when meeting the patient for the initial visit; during a flare-up of a known concern or when a new manifestation appears in a client presently receiving treatment, provides a clinician with answers in a matter of minutes while they are with the patient or about to see the patient (Clifford,2018).

The health cost savings associated with POCT have been shown to benefit the institutions that use it. The speed with which a physician gets a response makes a diagnosis and implements a substantially enhanced treatment plan when using Point of care testing. It also contributes to a patient’s duration of stay in a healthcare institution, allowing the clinician and other healthcare proffesionals to care for more patients while keeping healthcare costs per patient low. Additionally, it has been shown that when patients are released with wearable monitoring and testing equipment, readmittance is substantially decreased (Clifford,2018).

The technology used to conduct tests at the POC has improved, allowing for the development of simple-to-use. These portable devices can be linked with other hospital applications inside a facility. It creates a more secure data interchange environment and guarantees that patient data is current and easily accessible to any healthcare professional treating the patient. Additionally, the software included in these devices has advanced to offer analysis-based findings without the need for clinical personnel to be trained in the intricacies of interpretative science (Kankaanpää et al., 2016).

Evaluation of process and possible outcomes

The implementation of the use of Point of Care Testing will be done daily to estimate the time needed for the patient to receive care when POC is applied compared to the uses of Central laboratory services. Although POC can be used to run all tests, and some of them will need to be conducted in the general laboratory, POC testing will help to reduce the crowding in the Emergency Department. The process of POC will be conducted mainly by bedside nurses rather than laboratory professionals, which may be outside their scope of practice. The expected outcome will include reduced overcrowding of the emergency department and reducing the emergency department’s length of stay. Additionally, patients with life-threatening conditions will be served faster, thereby preventing avoidable deaths that mainly occur in the emergency departments.

Recommendations

Many nurses may be incompetent to perform some POC tests, while others may be unwilling to help in POC testing since it is outside their scope of practice. As much I uphold this POC to be implemented in the healthcare system, I also recommend that such tests, however minor they are to be conducted by laboratory professionals while observing the utmost code of ethics possible. This will increase the accuracy of results and improved and safe care to the patient.

Ethical or cultural considerations

Numerous ethical dilemmas confront the diagnostic medical laboratory. Direct access testing, standards of behavior, conflicts of interest, Consent, lab use, proficiency, and confidentiality are all significant ethical issues that are often more common in resource-constrained situations. Diagnostic and therapeutic choices are often made based on the outcomes and analyses of laboratory test findings. As a result, ethics is critical in laboratory medicine. Apart from the laboratory’s findings, the laboratory’s personnel are another critical component. Thus, it is strongly suggested that understanding ethics contribute to the protection of staff trust, operational integrity, competence, impartiality, and safety. Since most of these POC tests are conducted by nurses, they should display utmost confidentiality and apply the principle of beneficence to ensure maximum benefit to the patient.

 

 

Conclusion

By excluding the time consumed in the central laboratory, POCT alone reduced patient Length of Stay. While several patients continue to be seen in the central laboratory, POCT significantly decreased the LOS of many patients. Thus, the usage of POCT may be regarded to have a significant impact on the operation of the ED. The initial evaluation approach simplified the procedure and enabled a further reduction in LOS. The primary justification for this seems to be the second physician’s greater capacity to concentrate on patients who already have outcomes. However, it seems that a more extended period is required to fully implement and profit from a new working procedure in the ED. The Emergency Department continues to use both techniques in light of these findings. The objective is to shorten the time between admission and blood sample using a team triage approach at the registration stage rather than conducting triage and EAT independently. Additionally, healthcare professionals conducting the POC tests should display the highest code of ethics possible to ensure patient’s safety, privacy and improve the outcome.

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